Angiotensin receptor blockers for heart failure

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Chronic heart failure (HF) is a global health concern.
• Angiotensin receptor blockers (ARBs) are frequently prescribed for HF, but their efficacy remains debated.

Purpose of the Study:

• To evaluate the benefits and harms of ARBs versus ACE inhibitors (ACEIs) or placebo.
• To assess effects on mortality, morbidity, and adverse event-related withdrawals in HF patients with varying ejection fractions.

Main Methods:

• Systematic review and meta-analysis of double-blind randomized controlled trials.
• Included patients with symptomatic HF (NYHA Class II-IV) and either left ventricular systolic dysfunction (LVEF ≤40%) or preserved ejection fraction (LVEF >40%).
• Data extracted independently by two authors, assessing risk of bias.

Main Results:

• ARBs did not reduce total mortality or hospitalizations compared to placebo in patients with LVEF ≤40%.
• No significant differences in mortality, hospitalization, myocardial infarction, or stroke were observed between ARBs and ACEIs, but ARBs had fewer adverse effect withdrawals.
• In patients with LVEF >40%, ARBs did not reduce mortality or hospitalizations compared to placebo. Overall, ARBs showed higher adverse event withdrawals than placebo.
• Combination therapy with ARBs and ACEIs increased adverse event withdrawals without reducing mortality or hospitalizations.

Conclusions:

• ARBs do not improve total mortality or morbidity in symptomatic HF patients, regardless of ejection fraction, when compared to placebo or ACEIs.
• ARBs are better tolerated than ACEIs but less so than placebo regarding adverse event withdrawals.
• Adding ARBs to ACEIs increases adverse event withdrawals without offering additional mortality or hospitalization benefits.